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DOI: 10.1055/s-2000-325
Georg Thieme Verlag Stuttgart · New York
Economic Aspects of Different Muscle Relaxant Regimens*
Publication History
Publication Date:
31 December 2000 (online)
Wirtschaftliche Aspekte bei der Anwendung verschiedener Muskelrelaxantien.
Ziel der Studie: Mit der Umsetzung des Gesundheitsstrukturgesetzes treten wirtschaftliche Erwägungen bei der Anwendung neuer Anästhetika zunehmend in den Vordergrund. In einer Kostenanalyse sollen vier verschiedene mittellang wirkende, nicht depolarisierende Muskelrelaxantien, darunter die neuen Substanzen Cisatracurium und Rocuronium, gegenübergestellt werden. Methodik: 80 Patienten der ASA-Klassifikation I bis III, die sich einer laparoskopischen Cholecystektomie unterziehen mußten, wurden prospektiv, randomisiert einer von vier Gruppen zugeteilt. Alle Patienten erhielten eine Standardnarkose mit Desfluran und Fentanyl. Zur Muskelrelaxierung wurde entweder Atracurium, Cisatracurium, Vecuronium oder Rocuronium verwendet. Die Überwachung der neuromuskulären Blockade erfolgte intraoperativ durch serielle Train-of-Four (TOF) Stimulation. Ergebnisse: In allen Gruppen vergleichbar waren die biometrischen Daten, die Dauer des Eingriffs und der Narkose, die Anzahl der Patienten mit Antagonisierung der neuromuskulären Blockade, die Verweildauer im Aufwachraum, sowie die Inzidenz von unerwünschten postanästhetischen Nebenwirkungen. Die signifikant niedrigsten Anästhesiekosten pro Patient wurden mit 18,27 Euro für die Atracurium Gruppe ermittelt (Cisatracurium: 26,71 Euro pro Patient; Vecuronium: 22,61 Euro pro Patient; Rocuronium 22,63 Euro pro Patient). Schlußfolgerung: Zusammenfassend läßt sich feststellen, daß die Verwendung von Cisatracurium zu den höchsten Anästhesiekosten pro Patient beiträgt. Der Einsatz der neuen Muskelrelaxantien läßt sich wirtschaftlich nur rechtfertigen, wenn sich signifikante Verbesserungen der Anästhesiequalität erzielen lassen.
Summary.
Objective: At a time of cost reduction in medical care efforts to manage the ever-increasing costs of new pharmaceutical drugs become increasingly important. Costs of four different muscle relaxant regimens including the new intermediate-acting neuromuscular blocking drugs (NMBD) cisatracurium and rocuronium will be analyzed. Methods: Eighty patients undergoing laparoscopic cholecystectomy were prospectively studied. All patients received standardized general anaesthesia with desflurane/fentanyl. Muscle relaxation was achieved with atracurium, cisatracurium, vecuronium, or rocuronium with 20 patients in each group. Intraoperatively muscle relaxants were added to maintain two twitches of the train-of-four (TOF) assessment. Results: There were no differences among the four groups regarding biometric data, duration of surgery and anesthesia, number of patients with reversal of neuromuscular blockade, and time of extubation. Length of stay in the postanesthesia care unit (PACU) and the incidence of side effects were similar in all groups. Total costs of used drugs were significantly lowest in the atracurium-treated patients (per patient: 18.27 Euro) and significantly highest in the cisatracurium group (26.71 Euro) compared with the other groups (vecuronium: 22.61 Euro; rocuronium: 22.63 Euro). Conclusion: It is summarized that the use of cisatracurium was associated with higher costs compared to a standard muscle relaxant regimen using atracurium, whereas patient outcome was the same in all study groups. The routine use of the newer NMBDs can only be justified economically, if considerable improvements to clinical practice can be demonstrated.
Schlüsselwörter:
Muskelrelaxantien - Pharmakoökonomie - Kosten
Key words:
muscle relaxants - pharmacoeconomics - costs
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Prof. Dr. Joachim Boldt
Department of Anesthesiology and Intensive Care Medicine Klinikum der Stadt Ludwigshafen
Bremserstr. 79
67063 Ludwigshafen